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To%EHD Page 2 of 4 2014-11-14 00:52:43(GMT) 12097626954 From: RAVINDER SINGH <br /> San Joaquin County <br /> � Q Environmental Health Department <br /> 1868 East Hazelton Avenue,,Stockton,California 95205-6232 NOV 13 2014 <br /> Telephone:(209)468-3420 Far:(209)468-3433 Web:.www.swov.org/ehd <br /> { RETURN TO COMPLIANCE CERTIFICATION ENVIRONME„;TALHEALTI <br /> DEPA(­ i°TIENT <br /> AnyIM NOR Violations noted'inthe"Notice to.Comply°in the attached Inspection Report must be corrected within 0 days of <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health.Department(EHD)address <br /> at the top of this form within 30.days of receipt of the Inspection Report. HSC25404:1:2(c)(1) <br /> All corrections to other violations noted in the attached Inspection Report.(IR)or Continuation Form,or disputes to any <br /> violations,are to be submitted using this certification and returned to EHD within 30 days unless otherwise specified in the <br /> Inspection Report. HSC25185(0)(3) <br /> Note:All EHD staff time associated with failing.to comply by the above noted;dates will be <br /> billed at the current hourly rate. <br /> For this certification to becomplete, the operator of the site must include: <br /> A statement documenting what corrective actions were taken or will be taken for each violation <br /> C.oples:of sample resultslmenifestsltraining records/other appropriate paperwork;andlorphotos verifying, <br /> corrections <br /> Inspection Date: October 14,2014 Inspected By: STACY RIVERA <br /> Facility Address: 508 W Charter Way; Stockton EPA ID 041 nct�2-c�G, 7Gp <br /> (.certify under penalty of law that: <br /> 1. I have corrected the violations.zpecified in the Inspection Report from the above-mentioned inspection date. <br /> 2. 1 have personally examined the fallowing documentation submitted as proof of compliance FOR EACH VIOLATION <br /> and I believe the information to be”,accurate, and complete: <br /> Photos Paperwork _Statement <br /> 3. 1 am authorized to.submit this certification an behalf of the.Respondent. <br /> 4. I am aware that there are.significant penalties for submittIng false information,,including the possibility of a fine <br /> and/or imprisonment for known violations. (HSC 25191) <br /> Name: n n fie+ rte.u , Title: <br /> Signature:/ _ Date: ! <br /> ._ ............--..__.....-.-..._..._....... . -- —- - <br />